Bullying culture in NHS starts at top, says royal college head

Authors: Tom Moberly

Publication date:
06 Mar 2017

A bullying culture in the NHS is being passed down “from the top,” the president of the Royal College of Surgeons has said.

Speaking at the Nuffield Trust’s Health Policy Summit last week, Clare Marx said that the health service needed to have a “zero tolerance” approach towards poor management behaviour. “I think attitudes and behaviours in healthcare come from the top,” she said. “We all hear about bullying cultures. I’m ashamed to say that I don’t know a chief executive who isn’t bullied from the top, and I think that is passed down.”

She added, “They have to be very good leaders not to actually pass on those sort of behaviours.

“So we need to stand up and say, ‘I’m not going to have this, and this is what I’m going to do about it. I’m going to ensure that I display the sort of behaviours I would like myself.’”

Responding to a question about Marx’s comments at a later session, Simon Stevens, chief executive of NHS England, said that the NHS had “further work to do” to ensure that honesty concerning gaps in performance did not tip over into inappropriate and bullying behaviour.

“The system is clearly under stress, and stress does not always produce the right kind of behaviours and conversations,” he said. “There is also a question about having honest conversations about performance gaps and accountability.” These conversations needed to be “calibrated correctly” so that there could be “honest and transparent conversations about where change needs to happen—and hasn’t done so far—without that being inappropriate or bullying per se,” Stevens said. “Getting that calibration right is a challenge for all of the national bodies, and we’ve got further work to do.”

Marx also argued that senior doctors needed to recognise what they should do to improve morale in the workforce. “As leaders, as consultants in secondary care, we need to wake up in the morning and smell the coffee,” she said. “We need to realise that we’ve had the most incredible careers, and now it’s actually the time for us to pay back into that system, and we need to stand up and be counted.”

She said that leaders in the profession needed to do more to recognise the contributions of doctors in training. “You actually say to them, ‘You’ve done a fantastic job,’” she said. “You really draw them into the whole team ethos. You listen to them and you make them feel valued. I’m ashamed to say that too often senior clinicians are passing up that opportunity.”

Martin Green, chief executive of Care England, a charity that represents independent care service providers in England, said that the health service needed to be better at recognising good work. “We’ve also got to get much better at validating good practice: telling people what they’ve done well and doing that in real time, if possible,” he said.

“If we’re not careful, we spend a lot of our time telling people what they do wrong but not telling them how they delivered a really good service—and that really helps to give people an understanding of what good looks like.”

In the same session, which focused on “energising your workforce in the face of adversity,” Helen Stokes-Lampard, chair of the Royal College of General Practitioners, said that the NHS needed to get the basics right where motivating the workforce was concerned.

“Relationships with my colleagues are fantastic. I know all my colleagues. They are wonderful,” she said. “What we’re all struggling with is the whopping great elephant in the room, which is the time and the resource [needed] to do a safe job. It has to be a safe environment, and [we have to have the] ability to practise effectively and safely. We’ve got to get that right.”